Why do I have so much trouble sleeping and what can I do about it?

Insomnia, or difficulty sleeping, is one of the most common complaints I hear every day. Patients typically report having trouble falling asleep, staying asleep, or both. It is important to discuss this with your doctor to determine if a medical condition may be contributing to your symptoms. Poor sleep is detrimental to both mental and physical health and can increase risk for high blood pressure, stroke, heart attack, diabetes, depression, and obesity. You can often improve your sleep by engaging in good "sleep hygiene" practices: keep sleep and wake times consistent, even on weekends, turn off electronics 1-2 hours prior to bed, keep your bedroom cool and dark, and limit bedroom activities to only sleep and sex. Deep breathing for 5 minutes prior to bedtime can lower blood pressure and induce sleep. Over the counter supplements such as melatonin and Benadryl (found in Tylenol-PM, Aleve-PM, and ZzzQuil) may be helpful but should always be discussed with your doctor. Prescription sleep medications may be appropriate, but benefits and potential risks should always be taken into consideration and only after an appropriate medical workup.

What are the signs of hypothermia and how do you treat it?

Hypothermia is a serious condition in the winter, especially with bitter cold temperatures. Those at particular risk often include the elderly or homeless who may not have adequate access to heat or shelter, newborn infants, or people caught outside for unanticipated lengths of time, such as sports enthusiasts or those involved in a motor vehicle accident . Excessive alcohol intake can also contribute to risk of hypothermia. Hypothermia is a medical emergency and prompt treatment is essential. The main symptoms include a change in mental status, such as confusion, dizziness, mood change, and slurred speech. Early hypothermia presents with vigorous shivering, hyperventilation, and racing heart. As the body temperature drops further, mental status deteriorates into a stupor, pupils become fixed and dilated, and the pulse rate slows, putting the patient at risk for lethal arrhythmias. If untreated, further progression can lead to coma and death. Treatment should always begin with preventing further heat loss, removing any wet clothing and covering the person with warm dry blankets or clothing, placing an external heat source such as hot water bottles in the armpits, groin, and abdomen, and contacting 911 immediately. If a person is unresponsive, CPR should be performed until emergency personnel arrive. Anyone treated for even mild hypothermia should be taken to the emergency room for monitoring until normal core temperature is achieved. Prevention of hypothermia is essential. Pack extra blankets, clothing and footwear, along with food and water if traveling, and check on elderly family or neighbors if severe cold is anticipated. If required to be outside, dress in layers, drink warm non-alcoholic liquids and take frequent breaks to go inside and warm up.

What is Seasonal Affective Disorder?

Seasonal Affective Disorder is a type of depression that typically manifests itself in the fall and winter months. Symptoms vary from feeling sad to irritability, extreme fatigue, apathy, or even anxiety. The extended period of limited sunlight during winter months tends to play a significant role in seasonal affective disorder. Many people can treat their symptoms with small, regular doses of sunlight during the day or by purchasing a UV light to use in their homes. Vitamin D3 purchased over the counter may also help. Exercising regularly is an excellent way to stimulate the brain's natural production of serotonin and endorphins which can improve mood and energy. Yoga and meditation particularly can reduce levels of the stress hormone cortisol. Sleeping least 7-8 hours on a regular schedule and maintaining proper nutrition can also help. If symptoms are not able to be managed with lifestyle, or if existing depression and anxiety are worsening, it may be time to talk with your physician about medication and/or referral to a licensed counselor or psychologist. Antidepressant medications may be used during the winter months to ease symptoms in conjunction with a healthy lifestyle. Cognitive behavioral therapy is an excellent option for people wishing to avoid medication. Fortunately when the sunlight returns and the weather warms, Seasonal Affective Disorder often abates and medications can be discontinued. However, it is important to maintain those healthy lifestyle changes year round because winter returns at the same time every year!

How can I make the most of my doctor appointment?

In today's world, doctor appointments seem to get shorter while wait times are often longer. In order to get the most out of your appointment (and to help cut down on overall wait time by improving patient flow), you can do a few things to be prepared for your visit. First, arrive early and have all necessary documentation, including insurance card, valid photo ID, and any payment required by your insurance. Bring completed new patient forms if it is your first time to the office. Know your medical history, including surgeries, hospitalizations, and drug allergies. Bring a list of your medication names, dosages, and how often you take them. Make a list of all questions for the doctor and be sure they are addressed to your satisfaction. Bring any needed Xrays or other test results and any readings, such as blood pressure or sugar that you monitor at home . Take notes, record the conversation on your phone, and be sure to ask for any needed clarification before you leave. Ask the physician to write down instructions or give you a summary of your visit. Repeat the information back to be sure you understand correctly. Going to the doctor can be overwhelming, so consider bringing a friend or family member to give support or help you remember. Keep in mind that numerous complicated problems may require multiple visits so don't hesitate to schedule another appointment if you can't address every issue at one time. Once you build a relationship with your primary care provider, visits will become more efficient and smoother. And always feel free to call back if you remember a question or develop a new concern after the visit is over. Together you and your doctor can create a health care team experience that will keep you healthy and happy for a lifetime!

Who should get a flu shot and when?

The CDC recommends a yearly flu shot for everyone aged 6 months and older. The flu vaccine prevents millions of cases of Influenza each year and significantly reduces hospitalizations, serious adverse medical events, and mortality. Pregnant women should receive the flu shot as it protects them as well as the newborn baby for several months after birth. Getting vaccinated can also protect others by limiting transmission of the virus, including those who may be unable to receive the flu vaccine due to allergy or other contraindication (such as a history of Guillian-Barre syndrome). Seniors may be especially at risk for serious complications, and a high-dose vaccine is recommended for people over the age of 65. Even if the virus mutates during the season and a patient still gets the flu, the vaccine provides cross-protection among virus subtypes, resulting in less severe illness than if the individual had not been vaccinated. The CDC recommends getting vaccinated by the end of October, since it takes 2 weeks to become fully immune. However, it is better to be vaccinated later in the season than not at all. Vaccines are available through most pharmacies, health departments, and many health care providers.